Combination of abdominoplasty and liposuction

Liposuction options and their impact on abdominoplasty results

The introduction of liposuction into clinical practice has significantly expanded the capabilities of plastic surgeons in aesthetic correction of body contours. The combinations of liposuction and abdominoplasty are varied, and the choice of surgeon is based on an understanding of the specific features of the influence of liposuction on the results of abdominoplasty that are inherent in the specific operation performed.

First of all, it is obvious that the combination of liposuction and abdominoplasty, while improving the possibilities of body contour correction, can significantly worsen the conditions for healing the main wound. The pathogenetic mechanisms of this effect are:

• the general impact of additional (liposuction-related) tissue trauma on the general condition of the patient, and consequently on the course of reparative processes in the main wound;
• direct influence on the healing processes of the main wound (formed after abdominoplasty) in cases where there is a damaged area treated during liposuction located next to it.

This determined three main options for the surgeon's tactics, which include performing liposuction before abdominoplasty (a separate stage), during plastic surgery of the anterior abdominal wall, and after this intervention (the second stage).

Preliminary liposuction

Preliminary liposuction is indicated when the subcutaneous fat layer on the anterior abdominal wall is too thick, which can worsen the aesthetic result of the operation and increase the likelihood of postoperative complications. This also applies to the situation when the main fat "trap" is located along the midline of the abdomen, but the patient refuses vertical abdominoplasty. In these cases, liposuction of the abdomen (in particular, the epigastric region) in combination with the treatment of the flanks and lateral surfaces of the body allows to significantly reduce the thickness of the skin-fat flap and thereby improve the outcome of subsequent abdominoplasty. It is quite clear that the period between these two interventions should be at least 3-4 months.

Liposuction during abdominoplasty

It has now been established that liposuction in areas adjacent to the main wound significantly worsens the conditions for its healing and increases the likelihood of complications. If liposuction is performed through the wall of the main wound (for example, treatment of the lateral parts of the abdomen and flanks), the latter is connected by numerous channels to the liposuction zone.

As a result, wound exudate, which forms in significant quantities in the area of adipose tissue removal, is able to move into the main wound of the anterior abdominal wall, which determines the high probability of seroma formation.

For these reasons, only three types of surgery have become widespread in clinical practice:

• limited-scale liposuction of the edges of the main wound (during any type of abdominoplasty) to eliminate (reduce) the formation of “ears” at the extreme points of horizontal access and/or the convexity of the skin suture in the epigastric region that occurs during vertical abdominoplasty;
• large-scale liposuction in the flanks and lateral parts of the body, which is performed from additional approaches remote from the main wound, as a result of which the liposuction wound zone is not directly connected to the main wound;
• moderate-scale liposuction, which is performed through the wall of the main wound with minimal detachment of skin-fat flaps and the “dead” space formed in the wound.

It is dangerous to perform large-scale liposuction through the wall of the main wound with extensive detachment of skin and fat flaps (during abdominoplasty) due to the high incidence of postoperative complications.

Liposuction after abdominoplasty

Performing liposuction after abdominoplasty is usually the least preferred option for body contouring, since thinning of the subcutaneous fat layer of the anterior abdominal wall leads to skin relaxation and worsens the aesthetic result of abdominoplasty. Exceptions to this rule occur when there is a significant difference in the thickness of the tissues located above and below the scar line. Additional liposuction may also be advisable when "ears" form at the extreme points of the horizontal scar.